Congress Delivers Historic Two-Year Medicare Telehealth Extension

House Passes HR 7148 with Unprecedented Waiver Period Through 2027

By Elena Pak, Credentialing Department, WCH

Legislative Status as of January 27, 2026

Last Thursday, the House of Representatives passed HR 7148, the Consolidated Appropriations Act, 2026, marking a pivotal moment in telehealth policy. As of this publication, the legislation has cleared the House but awaits Senate consideration and, if passed, presidential signature. This comprehensive appropriations bill includes the FY 2026 funding package for Labor, Health and Human Services (LHHS), Education, and Related Agencies, with a groundbreaking extension of Medicare telehealth waivers through December 31, 2027.

This represents the longest extension period to date, providing nearly two years of regulatory stability for healthcare providers and patients nationwide. The significance of this extended timeline cannot be overstated – it marks a fundamental shift from short-term emergency measures to a more strategic, long-term approach to virtual care policy.

For the full legislative text, stakeholders can review HR 7148 on Congress.gov. Healthcare administrators and policy analysts should monitor the Senate legislative calendar closely as the January 31, 2026, deadline approaches.

Critical Provisions Extended Through December 31, 2027

The legislation extends seven essential telehealth waivers that have become foundational to modern healthcare delivery:

Geographic and Site Location Requirements – The waiver eliminates the historic restriction that limited telehealth services to patients in designated rural areas or approved healthcare facilities. Under this extension, patients can receive telehealth services from any location, including their homes, workplaces, or while traveling. This flexibility has proven essential for maintaining continuity of care and reducing barriers to access, particularly for beneficiaries in suburban and urban areas previously excluded from Medicare telehealth coverage.

Expanded List of Eligible Telehealth Providers – The legislation maintains a broader range of healthcare professionals eligible to deliver virtual care services under Medicare reimbursement. This includes physical therapists, occupational therapists, speech-language pathologists, and other specialists who previously faced restrictions. This ensures patients can access comprehensive, multidisciplinary care teams through telehealth platforms without artificial provider-type limitations.

FQHC and RHC Telehealth Eligibility – Federally qualified health centers (FQHCs) and rural health clinics (RHCs) can continue serving as eligible telehealth distant-site providers. These safety-net institutions serve predominantly low-income, uninsured, and underserved populations, often in Health Professional Shortage Areas. Maintaining their telehealth capabilities is critical for health equity, particularly in medically underserved communities where these centers often represent the only accessible healthcare option within reasonable travel distance.

Mental Health In-Person Visit Requirements – Two separate but related provisions address mental health access barriers. First, the legislation delays the prior in-person visit requirement for mental health services when certain permanent telehealth policy requirements are not met. Second, it specifically delays this requirement for mental health services provided via telecommunications technology for FQHCs and RHCs.

These provisions are particularly critical for patients experiencing mental health crises, those with mobility limitations, agoraphobia, or severe anxiety disorders that make in-person visits challenging, and individuals in areas with severe mental health workforce shortages. The flexibility to initiate mental health treatment virtually without a prior face-to-face encounter can literally be lifesaving, eliminating a significant barrier that might otherwise delay or prevent treatment initiation.

Audio-Only Services – The extension preserves the ability to deliver and receive Medicare reimbursement for audio-only telehealth services. This provision addresses a critical equity issue: many Medicare beneficiaries, particularly seniors in rural areas and low-income populations, lack access to video-capable devices, reliable broadband internet, or the digital literacy to navigate video platforms. Audio-only services ensure these vulnerable populations maintain access to care rather than being excluded by technology barriers. This is especially important for routine follow-ups, medication management, and behavioral health services.

Hospice Care Recertification – The extension continues allowing telehealth for face-to-face encounters required for recertification of hospice care eligibility. Medicare requires periodic physician certification that patients remain terminally ill to continue hospice benefits. This provision maintains dignity and reduces burden for terminally ill patients and their families, eliminating the need for difficult travel during end-of-life care while ensuring appropriate clinical oversight and regulatory compliance.

Acute Hospital Care at Home Initiative – Extended Timeline Through 2030 – Receiving special attention with a significantly longer timeline than other provisions, this innovative program is extended through September 30, 2030. This represents a notable exception to the December 2027 timeline applicable to other waivers. The initiative allows hospitals to provide acute-level care in patients’ homes using remote monitoring, virtual visits, and home-based clinical services for conditions traditionally requiring hospital admission.

The extended timeline through 2030 reflects recognition that this program requires longer-term evaluation to assess clinical outcomes, patient safety, cost-effectiveness, and scalability. This differential timeline is intentional and does not indicate extension of other telehealth waivers beyond December 2027.

Political Landscape and Immediate Risks

While House passage represents significant progress, the path forward remains uncertain. The legislation now moves to the Senate, where timing and prospects have become complicated by external political factors. The telehealth provisions are embedded within a broader appropriations bill that has become entangled with Department of Homeland Security (DHS) funding debates that emerged over the weekend.

This political complication creates genuine risk for telehealth continuity. Without Senate passage and presidential signature by January 31, 2026, the waivers will expire, and Medicare telehealth policy would revert to the restrictive permanent framework established before the COVID-19 pandemic under the Benefits Improvement and Protection Act of 2000 and subsequent regulations.

Lessons from the Previous Expiration: October-November 2025

The consequences of such a lapse are not theoretical – they occurred as recently as last fall, during October and November 2025, when a previous temporary extension expired before Congress passed retroactive coverage. That two-month experience provides a concrete roadmap for what providers and patients could face again.

During that period, healthcare providers confronted difficult operational decisions with significant clinical and financial implications. They had to choose between three imperfect options:

First, reschedule telehealth appointments that would not qualify under permanent policies to a later date, hoping for eventual extension passage. This option disrupted continuity of care and created scheduling backlogs.

Second, convert scheduled virtual visits to in-person appointments, potentially creating access barriers for patients with transportation limitations, mobility issues, or work schedule conflicts, while also overwhelming clinic capacity not designed for sudden influx of in-person visits.

Third, continue holding scheduled telehealth appointments and billing for them despite regulatory uncertainty, gambling that any future policy solution would include retroactive coverage for services provided during the lapsed period.

Many providers chose the third option during the previous lapse, and ultimately Congress did provide retroactive coverage when the extension finally passed in late November 2025. However, this created weeks of financial uncertainty and substantial administrative burden as providers tracked potentially non-reimbursable services, prepared for possible payment denials, set aside financial reserves, and managed patient communications about potential out-of-pocket liability.

Strategic Implications of the Two-Year Timeline

Unlike the previous three Medicare telehealth waiver extensions, which provided only short-term certainty of three to six months, this proposal covers almost two years. This extended timeframe represents more than just administrative convenience – it signals a maturation in how policymakers approach telehealth policy and recognition that healthcare systems require stability for strategic planning.

The two-year waiver period should provide substantially greater stability and operational confidence to providers and patients. Healthcare organizations can make strategic investments in telehealth infrastructure, staff training, workflow optimization, and program development with confidence that regulatory support will remain in place long enough to achieve return on investment. Medical groups can recruit and onboard clinicians with telehealth responsibilities without concern about imminent program disruption.

Patients can establish ongoing virtual care relationships with their providers without fear of abrupt service termination requiring switching to in-person-only care or finding new providers. This continuity is particularly important for chronic disease management, behavioral health treatment, and specialty care relationships.

Perhaps most importantly, this extended timeline creates space for more thoughtful, evidence-based discussion around potentially finding a more permanent solution to these telehealth policies. Rather than rushing to extend waivers every few months in crisis mode, policymakers will have time to:

• Analyze comprehensive outcomes data on quality, safety, and patient satisfaction
• Evaluate fiscal impacts on the Medicare Trust Fund and compare costs to traditional in-person care
• Assess utilization patterns and identify potential overuse or underuse
• Develop sustainable long-term frameworks that balance access, quality, cost, and fraud prevention
• Consider geographic and demographic equity implications
• Gather stakeholder input from providers, patients, payers, and technology vendors
• Draft permanent legislation with appropriate guardrails and quality measures

Additional Provisions of Significance

Beyond the core waiver extensions, HR 7148 includes several other important telehealth-related measures that deserve attention:

Federal Investment: $45.5 Million to the Office for the Advancement of Telehealth – The bill allocates $45.5 million to the Office for the Advancement of Telehealth within the Health Resources and Services Administration (HRSA). This represents significant federal commitment to telehealth infrastructure development, technical assistance, provider training, and program evaluation. These funds support the Telehealth Network Grant Program, Telehealth Resource Centers, and evidence generation activities. This allocation is specified in the LHHS appropriations section of HR 7148.

Billing Transparency and Platform Identification – By 2027, the Centers for Medicare and Medicaid Services (CMS) will be required to implement billing modifiers that identify telehealth services delivered through third-party virtual platforms with whom clinicians have contractual or payment arrangements, and when telehealth is billed “incident to” another professional service.

To clarify: “incident to” services are those provided by non-physician practitioners (such as nurse practitioners or physician assistants) under the supervision of a physician and billed under the physician’s provider number. This billing mechanism has raised oversight questions in telehealth contexts where the supervising physician may be remote or minimally involved.

The new modifier requirement addresses growing concerns about transparency, appropriate supervision, quality oversight, and the role of technology intermediaries in healthcare delivery, particularly regarding direct-to-consumer telehealth platforms.

Cardiopulmonary Rehabilitation Services – Through calendar year 2027, hospitals can furnish and bill Medicare for cardiopulmonary rehabilitation services delivered to hospital outpatients in their homes via live video. This provision recognizes that cardiac and pulmonary rehabilitation – traditionally facility-based services involving supervised exercise and education – can be effectively delivered remotely for appropriate patients, expanding access for those with mobility limitations, transportation barriers, or who live far from rehabilitation facilities.

Health Equity: Limited English Proficiency Guidance – Within one year of enactment, the Department of Health and Human Services must issue guidance on best practices for delivering telehealth services to patients with limited English proficiency (LEP). This requirement addresses persistent health equity concerns and ensures virtual care expansion does not inadvertently widen disparities for the approximately 25 million Americans with LEP. Guidance is expected to address interpretation services, translated materials, platform accessibility, and culturally appropriate care delivery in virtual settings.

Clinical Quality: Movement Disorder Screening – By January 1, 2028, CMS must educate Medicare clinicians on screening for medication-induced movement disorders in at-risk patients, including best practices for telehealth-based screening and proper billing documentation. This provision recognizes that certain clinical assessments – particularly neurological examinations like assessment for tardive dyskinesia or Parkinsonism – require specific protocols and potentially adapted techniques in virtual environments to ensure clinical validity.

Transparency for Beneficiaries: Medicare Advantage Directories – Medicare Advantage plans must include telehealth capabilities in provider directories, enabling beneficiaries to make informed choices about their care options and identify which providers offer virtual services, what modalities they use (video vs. audio), and for which types of visits. This addresses widespread beneficiary confusion about telehealth availability within MA networks.

Rural Veteran Support: $1 Million Allocation – The legislation allocates $1 million specifically for purchasing and implementing telehealth services and related efforts to improve healthcare coordination for rural veterans between rural providers and the Department of Veterans Affairs. This funding addresses the unique challenges rural veterans face accessing VA care, often requiring long-distance travel to VA facilities, and supports partnerships between VA and community providers using telehealth to bridge gaps.

Bottom Line and Action Items

HR 7148 represents a critical inflection point in American telehealth policy. The historic two-year extension provides unprecedented stability for virtual care delivery, enabling strategic planning and investment while creating space for thoughtful development of permanent solutions.

However, Senate passage remains the immediate hurdle requiring attention. As the January 31, 2026 deadline approaches, healthcare providers, policymakers, patient advocates, and technology stakeholders must remain vigilant and engaged. The lessons from last fall’s October-November expiration demonstrate that temporary lapses create real consequences for patients and providers alike.

The stakes extend beyond administrative convenience – they encompass access to care for millions of Medicare beneficiaries, the financial viability of telehealth programs that healthcare systems have built over the past years, and the future trajectory of American healthcare delivery in an increasingly digital age.

Immediate Actions for Healthcare Organizations:

• Monitor Senate legislative activity through Congress.gov and CMS announcements
• Review current telehealth service volumes and identify services at risk under permanent policy
• Prepare contingency plans for potential January 31 lapse, including patient communication templates
• Document telehealth outcomes data to support future permanent policy discussions
• Engage with professional associations and congressional representatives to advocate for passage

WCH Anniversary Webinar Series

In celebration of WCH’s anniversary, we launched a special webinar series. On January 27, we hosted a comprehensive session dedicated to all major telehealth updates.

Our expert panel broke down the complex provisions, answered practitioner questions, and provided actionable guidance for navigating the current uncertainty while preparing for various legislative outcomes.

Subscribe to our newsletter to receive the complete session breakdown, expert analysis, implementation toolkit, and actionable insights on February 5.